A Multicenter, Open-Label, Phase 3 Trial to Compare the Efficacy and Safety of Lenvatinib (E7080) Versus Sorafenib in First-line Treatment of Participants With Unresectable Hepatocellular Carcinoma

NCT ID: NCT01761266

Last Updated: 2022-04-05

Study Results

Results available

Outcome measurements, participant flow, baseline characteristics, and adverse events have been published for this study.

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Basic Information

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Recruitment Status

COMPLETED

Clinical Phase

PHASE3

Total Enrollment

954 participants

Study Classification

INTERVENTIONAL

Study Start Date

2013-03-01

Study Completion Date

2021-03-10

Brief Summary

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E7080-G000-304 is a multicenter, randomized, open-label, noninferiority Phase 3 study to compare the efficacy and safety of lenvatinib versus sorafenib as a first-line systemic treatment in participants with unresectable Hepatocellular Carcinoma (HCC).

Detailed Description

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Conditions

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Hepatocellular Carcinoma (HCC)

Study Design

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Allocation Method

RANDOMIZED

Intervention Model

PARALLEL

Primary Study Purpose

TREATMENT

Blinding Strategy

NONE

Study Groups

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Lenvatinib

Participants received lenvatinib capsules 12 milligram (mg) based on the participant's body weight greater than or equal to (\>=) 60 kilogram (kg) or 8 mg based on the participant's body weight less than (\<) 60 kg at baseline, orally, once daily (QD) in continuous 28-day treatment cycles up to documented disease progression, development of unacceptable toxicity, participant request, or withdrawal of consent.

Group Type ACTIVE_COMPARATOR

Lenvatinib

Intervention Type DRUG

12 mg (or 8 mg) once daily (QD) oral dosing.

Sorafenib

Participants received sorafenib 400 mg tablets, orally, twice daily (BID) in continuous 28-day treatment cycles up to documented disease progression, development of unacceptable toxicity, participant request, or withdrawal of consent.

Group Type ACTIVE_COMPARATOR

Sorafenib

Intervention Type DRUG

400 mg twice daily (BID) oral dosing.

Interventions

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Lenvatinib

12 mg (or 8 mg) once daily (QD) oral dosing.

Intervention Type DRUG

Sorafenib

400 mg twice daily (BID) oral dosing.

Intervention Type DRUG

Other Intervention Names

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E7080, Lenvima

Eligibility Criteria

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Exclusion Criteria

1. Imaging findings for HCC corresponding to any of the following:

* HCC with \>=50 percent liver occupation
* Clear invasion into the bile duct
* Portal vein invasion at the main portal branch (Vp4).
2. Participants who have received any systemic chemotherapy, including anti-vascular endothelial growth factor (VEGF) therapy, or any systemic investigational anticancer agents, including lenvatinib, for advanced/unresectable HCC. Note: Participants who have received local hepatic injection chemotherapy are eligible.
3. Participants who have received any anticancer therapy (including surgery, percutaneous ethanol injection, radio frequency ablation, transarterial \[chemo\] embolization, hepatic intra-arterial chemotherapy, biological, immunotherapy, hormonal, or radiotherapy) or any blood enhancing treatment (including blood transfusion, blood products, or agents that stimulate blood cell production, eg, granulocyte colony-stimulating factor \[G-CSF\]) within 28 days prior to randomization.
4. Participants who have not recovered from toxicities as a result of prior anticancer therapy, except alopecia and infertility. Recovery is defined as \< Grade 2 severity per Common Terminology Criteria for Adverse Events Version 4.0 (CTCAE v4.0).
5. Significant cardiovascular impairment: history of congestive heart failure \> New York Heart Association (NYHA) Class II, unstable angina, myocardial infarction or stroke within 6 months of the first dose of study drug, or cardiac arrhythmia requiring medical treatment at Screening.
6. Prolongation of corrected QT interval (QTc) interval to \>480 millisecond (ms)
7. Gastrointestinal malabsorption or any other condition that might affect the absorption of lenvatinib in the opinion of the investigator.
8. Bleeding or thrombotic disorders or use of anticoagulants requiring therapeutic INR monitoring, eg, warfarin or similar agents. Treatment with low molecular weight heparin and factor X inhibitors which do not require INR monitoring is permitted. Antiplatelet agents are prohibited throughout the study.
9. Gastrointestinal bleeding event or active hemoptysis (bright red blood of at least 0.5 teaspoon) within 28 days prior to randomization.
10. Gastric or esophageal varices that require interventional treatment within 28 days prior to randomization. Prophylaxis with pharmacologic therapy (eg, nonselective beta-blocker) is permitted.
11. Active malignancy (except for HCC or definitively treated melanoma in-situ, basal or squamous cell carcinoma of the skin, or carcinoma in-situ of the cervix) within the past 36 months.
12. Participants whose only target lesion(s) is in bone will be excluded.
13. Meningeal carcinomatosis.
14. Any history of or current brain or subdural metastases.
15. Participants having \>1+ proteinuria on urine dipstick testing will undergo a 24-hour urine collection for quantitative assessment of proteinuria. Participants with a urine protein \>=1g/24 hours will be ineligible.
16. Surgical arterial-portal venous shunt or arterial-venous shunt.
17. Any medical or other condition that in the opinion of the investigator would preclude the participant's participation in a clinical study.
18. Known intolerance to lenvatinib or sorafenib (or any of the excipients).
19. Human immunodeficiency virus (HIV) positive or active infection requiring treatment (except for hepatitis virus).
20. Any history of drug or alcohol dependency or abuse within the prior 6 months.
21. Any participant who cannot be evaluated by either triphasic liver computed tomography (CT) or triphasic liver Magnetic resonance imaging (MRI) because of allergy or other contraindication to both CT and MRI contrast agents.
22. Major surgery within 3 weeks prior to randomization or scheduled for surgery during the study.
23. Participants has had a liver transplant.
Minimum Eligible Age

18 Years

Eligible Sex

ALL

Accepts Healthy Volunteers

No

Sponsors

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Merck Sharp & Dohme LLC

INDUSTRY

Sponsor Role collaborator

Eisai Limited

INDUSTRY

Sponsor Role lead

Responsible Party

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Responsibility Role SPONSOR

Locations

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Facility # 1

Los Angeles, California, United States

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Sacramento, California, United States

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San Francisco, California, United States

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Washington D.C., District of Columbia, United States

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Tampa, Florida, United States

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Duluth, Georgia, United States

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Lawrenceville, Georgia, United States

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Baltimore, Maryland, United States

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Detroit, Michigan, United States

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Kansas City, Missouri, United States

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St Louis, Missouri, United States

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East Orange, New Jersey, United States

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Brooklyn, New York, United States

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Lake Success, New York, United States

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New York, New York, United States

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Charlotte, North Carolina, United States

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Durham, North Carolina, United States

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Portland, Oregon, United States

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Austin, Texas, United States

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Lubbock, Texas, United States

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Seattle, Washington, United States

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Camperdown, New South Wales, Australia

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Wentworthville, New South Wales, Australia

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Woolloongabba, Queensland, Australia

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Fitzroy, Victoria, Australia

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Melbourne, Victoria, Australia

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Melbourne, Victoria, Australia

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Nedlands, Western Australia, Australia

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Brussels, , Belgium

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Edegem, , Belgium

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Liège, , Belgium

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Ottawa, Ontario, Canada

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Hefei, Anhui, China

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Beijing, Beijing Municipality, China

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Beijing, Beijing Municipality, China

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Beijing, Beijing Municipality, China

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Chongqing, Chongqing Municipality, China

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Fuzhou, Fujian, China

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Fuzhou, Fujian, China

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Guangzhou, Guangdong, China

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Harbin, Heilongjiang, China

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Changsha, Hunan, China

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Nanjing, Jiangsu, China

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Suzhou, Jiangsu, China

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Changchun, Jilin, China

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Dalian, Liaoning, China

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Jinan, Shandong, China

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Shanghai, Shanghai Municipality, China

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Shanghai, Shanghai Municipality, China

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Xi’an, Shanxi, China

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Xi’an, Shanxi, China

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Hangzhou, Zhejiang, China

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Tianjin, Zhejiang, China

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Nice, Alpes Maritimes, France

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Pessac, Gironde, France

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Toulouse, Haute Garonne, France

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Montpellier, Herault, France

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Rennes, Ille Et Vilaine, France

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Vandœuvre-lès-Nancy, Meurthe Et Moselle, France

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Amiens, Somme, France

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Créteil, Val De Marne, France

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Bordeaux, , France

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Lille, , France

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Lyon, , France

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Nord, , France

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Paris, , France

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Paris, , France

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Rhone, , France

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Heidelberg, Baden-Wurttemberg, Germany

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Tübingen, Baden-Wurttemberg, Germany

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Marburg, Hesse, Germany

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Hanover, Lower Saxony, Germany

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Cologne, North Rhine-Westphalia, Germany

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Essen, North Rhine-Westphalia, Germany

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Mainz, Rhineland-Palatinate, Germany

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Hong Kong, , Hong Kong

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Hong Kong, , Hong Kong

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Hong Kong, , Hong Kong

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Kowloon, , Hong Kong

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Petah Tikva, , Israel

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Torrette, Ancona, Italy

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Bari, , Italy

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Benevento, , Italy

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Bologna, , Italy

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Napoli, , Italy

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Napoli, , Italy

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Palermo, , Italy

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Roma, , Italy

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Nagoya, Aichi-ken, Japan

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Kashiwa, Chiba, Japan

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Matsuyama, Ehime, Japan

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Kurume, Fukuoka, Japan

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Sapporo, Hokkaido, Japan

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Sapporo, Hokkaido, Japan

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Nishinomiya, Hyōgo, Japan

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Kanazawa, Ishikawa-ken, Japan

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Kawasaki, Kanagawa, Japan

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Yokohama, Kanagawa, Japan

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Tsu, Mie-ken, Japan

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Ōmura, Nagasaki, Japan

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Ōsaka-sayama, Osaka, Japan

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Bunkyo-Ku, Tokyo, Japan

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Chuo-ku, Tokyo, Japan

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Koto-ku, Tokyo, Japan

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Minato-ku, Tokyo, Japan

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Musashino, Tokyo, Japan

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Shimonoseki, Yamaguchi, Japan

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Fukuoka, , Japan

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Hiroshima, , Japan

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Okayama, , Japan

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Osaka, , Japan

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Saga, , Japan

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Saga, , Japan

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Kuantan, Pahang, Malaysia

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George Town, Pulau Pinang, Malaysia

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Miri, Sarawak, Malaysia

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Batu Caves, Selangor, Malaysia

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Kuala Lumpur, , Malaysia

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Cebu City, , Philippines

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Cebu City, , Philippines

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Davao City, , Philippines

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Quezon City, , Philippines

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Quezon City, , Philippines

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Gdansk, , Poland

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Warsaw, , Poland

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Wroclaw, , Poland

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Arkhangelsk, , Russia

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Moscow, , Russia

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Moscow, , Russia

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Saint Petersburg, , Russia

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Saint Petersburg, , Russia

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Ufa, , Russia

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Singapore, , Singapore

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Singapore, , Singapore

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Singapore, , Singapore

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Singapore, , Singapore

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Goyang-si, Gyeonggi-do, South Korea

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Seongnam-si, Gyeonggi-do, South Korea

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Seongnam-si, Gyeonggi-do, South Korea

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Suwon, Gyeonggi-do, South Korea

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Daegu, Gyeongsangbuk-do, South Korea

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Hwasun, Jeollanam-do, South Korea

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Busan, , South Korea

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Busan, , South Korea

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Busan, , South Korea

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Incheon, , South Korea

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Seoul, , South Korea

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Seoul, , South Korea

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Seoul, , South Korea

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Seoul, , South Korea

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Seoul, , South Korea

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Seoul, , South Korea

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Seoul, , South Korea

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Seoul, , South Korea

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L'Hospitalet de Llobregat, Barcelona, Spain

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Santander, Cantabria, Spain

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Badajoz, , Spain

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Girona, , Spain

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Madrid, , Spain

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Madrid, , Spain

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Madrid, , Spain

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Madrid, , Spain

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Kaohsiung City, , Taiwan

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Kaohsiung City, , Taiwan

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Taichung, , Taiwan

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Taichung, , Taiwan

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Tainan City, , Taiwan

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Tainan City, , Taiwan

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Taipei, , Taiwan

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Taipei, , Taiwan

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Taipei, , Taiwan

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Taipei, , Taiwan

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Taipei, , Taiwan

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Taoyuan, , Taiwan

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Bangkoknoi, Bangkok, Thailand

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Pathum Wan, Bangkok, Thailand

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Ratchathewi, Bangkok, Thailand

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Muang, Changwat Chiang Rai, Thailand

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Muang, Chiang Mai, Thailand

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London, Greater London, United Kingdom

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London, Greater London, United Kingdom

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London, Greater London, United Kingdom

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Manchester, Greater Manchester, United Kingdom

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Liverpool, Merseyside, United Kingdom

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Glasgow, Strathclyde, United Kingdom

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Birmingham, West Midlands, United Kingdom

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Countries

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United States Australia Belgium Canada China France Germany Hong Kong Israel Italy Japan Malaysia Philippines Poland Russia Singapore South Korea Spain Taiwan Thailand United Kingdom

References

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Piscaglia F, Ikeda K, Cheng AL, Kudo M, Ikeda M, Breder V, Ryoo BY, Mody K, Ren M, Ramji Z, Sung MW. Association between treatment-emergent hypertension and survival with lenvatinib treatment for patients with hepatocellular carcinoma in the REFLECT study. Cancer. 2024 Apr 15;130(8):1281-1291. doi: 10.1002/cncr.35185. Epub 2024 Jan 23.

Reference Type DERIVED
PMID: 38261521 (View on PubMed)

Kudo M, Finn RS, Qin S, Han KH, Ikeda K, Cheng AL, Vogel A, Tovoli F, Ueshima K, Aikata H, Lopez CL, Pracht M, Meng Z, Daniele B, Park JW, Palmer D, Tamai T, Saito K, Dutcus CE, Lencioni R. Overall survival and objective response in advanced unresectable hepatocellular carcinoma: A subanalysis of the REFLECT study. J Hepatol. 2023 Jan;78(1):133-141. doi: 10.1016/j.jhep.2022.09.006. Epub 2022 Sep 20.

Reference Type DERIVED
PMID: 36341767 (View on PubMed)

Huynh J, Cho MT, Kim EJ, Ren M, Ramji Z, Vogel A. Lenvatinib in patients with unresectable hepatocellular carcinoma who progressed to Child-Pugh B liver function. Ther Adv Med Oncol. 2022 Aug 24;14:17588359221116608. doi: 10.1177/17588359221116608. eCollection 2022.

Reference Type DERIVED
PMID: 36051472 (View on PubMed)

Vogel A, Qin S, Kudo M, Su Y, Hudgens S, Yamashita T, Yoon JH, Fartoux L, Simon K, Lopez C, Sung M, Mody K, Ohtsuka T, Tamai T, Bennett L, Meier G, Breder V. Lenvatinib versus sorafenib for first-line treatment of unresectable hepatocellular carcinoma: patient-reported outcomes from a randomised, open-label, non-inferiority, phase 3 trial. Lancet Gastroenterol Hepatol. 2021 Aug;6(8):649-658. doi: 10.1016/S2468-1253(21)00110-2. Epub 2021 Jun 2.

Reference Type DERIVED
PMID: 34087115 (View on PubMed)

Okusaka T, Ikeda K, Kudo M, Finn R, Qin S, Han KH, Cheng AL, Piscaglia F, Kobayashi M, Sung M, Chen M, Wyrwicz L, Yoon JH, Ren Z, Mody K, Dutcus C, Tamai T, Ren M, Hayato S, Kumada H. Safety and efficacy of lenvatinib by starting dose based on body weight in patients with unresectable hepatocellular carcinoma in REFLECT. J Gastroenterol. 2021 Jun;56(6):570-580. doi: 10.1007/s00535-021-01785-0. Epub 2021 May 4.

Reference Type DERIVED
PMID: 33948712 (View on PubMed)

Briggs A, Daniele B, Dick K, Evans TRJ, Galle PR, Hubner RA, Lopez C, Siebert U, Tremblay G. Covariate-adjusted analysis of the Phase 3 REFLECT study of lenvatinib versus sorafenib in the treatment of unresectable hepatocellular carcinoma. Br J Cancer. 2020 Jun;122(12):1754-1759. doi: 10.1038/s41416-020-0817-7. Epub 2020 Apr 8.

Reference Type DERIVED
PMID: 32265508 (View on PubMed)

Yamashita T, Kudo M, Ikeda K, Izumi N, Tateishi R, Ikeda M, Aikata H, Kawaguchi Y, Wada Y, Numata K, Inaba Y, Kuromatsu R, Kobayashi M, Okusaka T, Tamai T, Kitamura C, Saito K, Haruna K, Okita K, Kumada H. REFLECT-a phase 3 trial comparing efficacy and safety of lenvatinib to sorafenib for the treatment of unresectable hepatocellular carcinoma: an analysis of Japanese subset. J Gastroenterol. 2020 Jan;55(1):113-122. doi: 10.1007/s00535-019-01642-1. Epub 2019 Nov 12.

Reference Type DERIVED
PMID: 31720835 (View on PubMed)

Evans TRJ, Kudo M, Finn RS, Han KH, Cheng AL, Ikeda M, Kraljevic S, Ren M, Dutcus CE, Piscaglia F, Sung MW. Urine protein:creatinine ratio vs 24-hour urine protein for proteinuria management: analysis from the phase 3 REFLECT study of lenvatinib vs sorafenib in hepatocellular carcinoma. Br J Cancer. 2019 Jul;121(3):218-221. doi: 10.1038/s41416-019-0506-6. Epub 2019 Jun 28.

Reference Type DERIVED
PMID: 31249394 (View on PubMed)

Kudo M, Finn RS, Qin S, Han KH, Ikeda K, Piscaglia F, Baron A, Park JW, Han G, Jassem J, Blanc JF, Vogel A, Komov D, Evans TRJ, Lopez C, Dutcus C, Guo M, Saito K, Kraljevic S, Tamai T, Ren M, Cheng AL. Lenvatinib versus sorafenib in first-line treatment of patients with unresectable hepatocellular carcinoma: a randomised phase 3 non-inferiority trial. Lancet. 2018 Mar 24;391(10126):1163-1173. doi: 10.1016/S0140-6736(18)30207-1.

Reference Type DERIVED
PMID: 29433850 (View on PubMed)

Other Identifiers

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2012-002992-33

Identifier Type: EUDRACT_NUMBER

Identifier Source: secondary_id

E7080-G000-304

Identifier Type: -

Identifier Source: org_study_id

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